NIH Director’s Blog, 10 November 2015 In recent years, there’s been a lot of talk about…

National Group Urges HHS to Classify Obesity Counseling and Treatment

Shape Up America! Wants to Extend Medicare Coverage for Obesity Treatment to All Obese Americans

WASHINGTON, Dec. 14, 2011 /PRNewswire-USNewswire/ — As the Department of Health and Human Services (HHS) considers what health benefits must be covered by new state insurance plans operating under the Affordable Care Act, one of the nation’s leading groups on healthy weight for life is encouraging HHS to follow the lead of its agency, the Centers for Medicare and Medicaid Services (CMS), by extending Medicare coverage for obesity screenings and physician-based counseling to the rest of the obese population.

Calling CMS’s November 29 coverage decision a “major step forward” in the nation’s fight against obesity, Shape Up America! is now advocating that HHS extend existing CMS policies to the estimated 70 million Americans who are obese (those with a Body Mass Index of 30 and above). Besides lauding the CMS decision to cover counseling for obese adults on Medicare, the organization is further pressing HHS to follow CMS’s earlier national coverage policy, which pays for surgical treatment for the severely obese (those with a BMI of 40 or higher or with a BMI of 35 and above if they have a chronic medical condition such as diabetes or high blood pressure). Because of the high prevalence of obesity and its correlation to many chronic diseases, this disorder is responsible for more health care expenditures than any other medical condition.

“As HHS defines the essential health benefits private insurance plans must cover under the Affordable Care Act, the agency should not overlook the pressing issue of combating obesity in America,” said Barbara J. Moore, Ph.D., president and CEO of Shape Up America! “Including comprehensive obesity counseling and evidence-based treatment regimens is justified to improve the health outcomes and reduce the costs associated with chronic diseases associated with obesity. Moreover, CMS’s coverage policies establish a solid foundation for HHS to act.”

According to Shape Up America!, there is an urgent need for public policy to address the difficult challenges affecting the more than 15 million adults and 2.7 million children who are severely obese and face a greatly increased risk of diabetes, high blood pressure, high cholesterol, asthma and osteoarthritis. Now comprising approximately 5.7 percent of the U.S. population, the severely obese are 2-3 times more likely to die of preventable disease than persons at a healthy weight. In fact, life expectancy for those with severe obesity can be reduced by as much as 8 to 12 years.

Because cost effectiveness is a major factor influencing HHS decision-making, Shape Up America! laid out the cost benefits of extending CMS policies to all obese Americans. Addressing the strong correlation between obesity and chronic disease, the organization cited findings from a Congressional Budget Office (CBO) issue brief, which reported that between 1987 and 2007 the difference in spending on obese individuals compared to those of normal weight increased from 8 percent to 38 percent – or almost a five-fold increase. Based on these findings, Shape Up America! cautioned that unless HHS intercedes to give obese Americans greater access to comprehensive obesity counseling and evidence-based treatment regimens, healthcare expenditures attributed to obesity will only increase from the estimated $198 billion a year currently spent on the direct and indirect costs of obesityto as much as $344 billion by 2018, or 21% of direct health care spending. Read More